Delivering a female with missing cervix: a case report

Authors received a case in our casualty, 26 years old, G2P1L1, with full term pregnancy, spontaneous conception, previous normal vaginal delivery, with labour pain. On evaluation, she was having uterine contraction, fetal heart rate normal, vitally stable, with no cervix on per speculum and per vaginal examination, with solid globular mass per rectum. She was shifted to emergency operation theatre with provisional diagnosis of uterine rupture or rectal perforation or pelvic mass. After delivering a live baby, uterus was intact, but there was an impacted mass in pouch of Douglas, it was a twisted ovarian mass, sent for histopathology examination. Post-operative period was uneventful, and patient was discharged with healthy baby with corrected pelvic anatomy.

Prevention of wound infection: a new technique

Background: Caesarean delivery is a major obstetrical surgical procedure aiming to save the lives of mothers and fetuses. Caesarean sections have a 5 to 20-fold greater chance of getting an infection compared with women who give birth vaginally. These infections can be in the organs within the pelvis, around the surgical incision. Microorganisms isolated from surgical site infection (SSI) were mostly from skin and vaginal flora. The most effective SSI prevention strategies involve a multi-faceted approach including protocols exercised before, during, and after surgery to reduce exposure and susceptibility to pathogens.Methods: It was a case control study conducted in our hospital on caesarean patients. Total 240 patients were recruited for study, divided into cases (DDT group) and control (SDT group). Demographic data collected and follow till 30 days of surgery. SSIs patients identified and treated.Results: Out of total 240 patients, mean age SDT, DDT and total patients were 28.46, 28.6 and 28.3 years respectively. Maximum numbers of cases were among multigravida (gravidity) and lower and lower-middle class (socioeconomic status). SSIs patients were seen mostly in SDT group, which was statistically significant. Among SSIs patient maximum numbers of patients were seen in age group of 18-22 years, primigravida and lower socioeconomic class. After their diagnosis most of the patients were treated with resuturing.Conclusions: SSI is common complication after caesarean section; it can be prevented by increasing the hygienic condition in laboring patients. Authors newer method can be a future option for maintaining the intraoperative hygiene.

A rare case of toxic epidermal necrolysis in pregnancy

Stevens-Johnson syndrome (SJS) is a group of toxic necrolytic group of disorder of skin and mucous membrane with significant morbidity and mortality. It is a highly serious allergic reaction to medications affecting the skin and mucous membranes. Pregnant women with SJS or toxic epidermal necrolysis (TEN) are a unique subset, and both conditions can simultaneously affect the mother and fetus. It is a rare condition with a reported incidence of one case per million people per year. Till date, few cases of pregnancy with SJS/TEN have been reported. We are reporting a case of 20-year-old primigravida with 31+3 weeks of gestation presenting with extensive toxic epidermal necrosis. Attack of SJS developing in pregnancy can be fatal because immunity is compromised. This patient was managed in our institute with involvement of multidisciplinary team and had a successful pregnancy outcome. Perinatal outcome was also good in this case.